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Updated: Dec 10, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial
Ming Chern Leong1, Geetha Kandavello1, Azlan Husin2
1Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia.
Insights
Elderly patients with atrial septal defect (ASD) and atrial fibrillation can safely undergo simultaneous left atrial appendage (LAA) and ASD closure. This combined procedure offers a feasible and effective treatment option for this patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Elderly patients with atrial septal defect (ASD) frequently experience chronic atrial fibrillation and significant left-to-right shunting.
- This demographic often presents complex clinical challenges requiring tailored treatment strategies.
Purpose of the Study:
- To evaluate the feasibility and safety of combined left atrial appendage (LAA) and ASD closure in elderly patients.
- To assess periprocedural and long-term outcomes of this dual intervention.
Main Methods:
- A retrospective review of six elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure between 2014 and 2019.
- Data collected included procedural success, device performance, and clinical outcomes over a mean follow-up of 32.8 months.
Main Results:
- All six patients (mean age 66.8 years) achieved procedural success with successful LAA occlusion and ASD closure.
- Simultaneous procedures resulted in shorter hospital stays.
- No device-related complications, thrombosis, or thromboembolic events were reported during follow-up, although all patients remained in atrial fibrillation.
Conclusions:
- Combined LAA and ASD closure is a safe and feasible option for elderly patients with significant ASD and atrial fibrillation.
- The simultaneous approach may offer advantages in terms of hospital resource utilization.
Background:
Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation.
Methods:
We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported.
Results:
Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS2 , CHA2 DS2 -VASc , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack.
Conclusions:
LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.
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